Was my OSA misdiagnosed?

[Pugsy]

Sorry...I got my time line screwed up...

Actually I go back to what I suggested...things seem to be well controlled with any of your settings so you are lucky in that regard...I sometimes need 18 to 20 cm for my REM stubborn events. That's why I say count your blessing that things are well controlled with a nice low pressure. Less chance for aerophagia to bother you or high pressures disturbing things.
Use what you feel lets you sleep best and more well rested. If higher pressures disturb your sleep then back off because they aren't needed. If lower pressures are rather stifling..increase as it won't hurt to use a little more pressure than you technically may need.
It isn't all about an AHI number...it's about sleeping good and feeling good too.

Did you get the module with your Devilbiss machine so that you could use the software? Devilbiss sells the software and cpap.com has it offered with the module at a discount. There's more data available from the software reports than you get with just using the smart codes but it may not be critical issue for you if you are feeling good and sleeping good...but the module so you can use a SD card to gather the more comprehensive data and the software can always be added later.

How about some different reading material since you don't need the other... since I couldn't remember for 2 hours what was going on with you.
http://www.devilbissclinicaleducation.c ... nology.pdf

[orlF]

Saw the question and the study

1. You are below 50 years of age
2. Your sleep condition is worst at REM stage
3. CPAP doesn't seem to work
4. You primary physician was not an ENT

So I am guessing no site of obstruction was analyzed
or flexible nasopharyngoscopy

In recent MRI guided studies the noticed that CPAP works great in lateral obstruction patterns but doesnt work any good in anterio-postior sites of obstruction
that could be the case
I will suggest you try a different approach with
Mandibular advance device (MAD) custom made from a dental sleep clinic
and repeat the oximetry you should see the difference the first day
or for a permanent solution try surgery by an ENT if you BMI is below 31

[zoocrewphoto]

Surgery is often NOT a good idea. Success rate is low and doesn't last long.

You seem to be implying that you are in the medical field. Since this is your first post to the forum,could you please introduce yourself?

[laserjobs]

Saw the question and the study

1. You are below 50 years of age
2. Your sleep condition is worst at REM stage
3. CPAP doesn't seem to work
4. You primary physician was not an ENT

So I am guessing no site of obstruction was analyzed
or flexible nasopharyngoscopy

In recent MRI guided studies the noticed that CPAP works great in lateral obstruction patterns but doesnt work any good in anterio-postior sites of obstruction
that could be the case
I will suggest you try a different approach with
Mandibular advance device (MAD) custom made from a dental sleep clinic
and repeat the oximetry you should see the difference the first day
or for a permanent solution try surgery by an ENT if you BMI is below 31

1. Yes
2. Yes
3. No, my O2 levels are not dropping below 88 anymore
4. Doctor is an ENT

You are correct that there was no obstruction analysis beyond a visual but he seemed confident about it in the report.
I made my own Mandibular advance device with a self molding kit to pull the lower jaw forward and it did not help.


Last night I ran my APAP at 5-10, it was no longer defaulting to the minimum setting and the 90% and 95% were different this time:
95th Percentile Pressure 6.0
90th Percentile Pressure 5.5
AHI 2.0
Pressure Plateau Time 0%
High Leak Flow Time 0%
NRI 0.75
EPI 1
While Breathing Hours Last Day 8.4

OxiMetry Report
Event Data SpO2 Pulse
Total Events 22 126
Time In Events(min) 19.8 64.6
Avg. Event Dur.(sec) 54.0 30.8
Index (1/hr) 2.7 15.2
% Artifact 0.1 0.2
Adjusted Index (1/hr) 2.7 15.3
%SpO2 Data
Basal SpO2(%) 93.5
Time(min) < 88% 0.0
Events < 88% 0
Minimum SpO2(%) 88
Avg. Low SpO2(%) 91.5
Avg. Low SpO2 < 88% ----
Pulse Data
Avg Pulse Rate(bpm) 65.7
Low Pulse Rate(bpm) 51

[Pugsy]

Do you happen to live at some sort of higher than usual altitude? The reason I asked was the base O2 number?
It's a bit lower than what would be considered normal for most people unless they had some sort of lung issue unless they lived at a higher altitude where oxygen in just thinner in general.

Also when reporting software results. It's helpful if you would include a brief report on how you feel...how you slept?
Numbers alone don't tell us the full story.

[laserjobs]

Do you happen to live at some sort of higher than usual altitude? The reason I asked was the base O2 number?
It's a bit lower than what would be considered normal for most people unless they had some sort of lung issue unless they lived at a higher altitude where oxygen in just thinner in general.

Also when reporting software results. It's helpful if you would include a brief report on how you feel...how you slept?
Numbers alone don't tell us the full story.

Slept well except for the damn mask hitting the bridge of my nose and waking me up. I think I know how to fix it so that should not be a problem going forward. As for altitude I live at 5000 ft above sea level.

[orlF]

Rule of thumb: In sleep medicine the patient is always right


Yes i am on the field of medicine, also patient that why i do almost all lines of treatment from snore pillows to multinivel surgery
Whatever it take to get a good night sleep starting from the less invasive always

Back to the topic:
If the studies suggest there is no other explanation for the arousal that OSA

And Cpap doesnt correct the arousal
As in the pulse events seen in the latest study

Localization the site of obstructiom is the key to solve the problem

In the year i had 2 patients similar cases
Nothing seem to work i did a ( drug induced sleep endoscopy with Precedex
And found huge lingual tonsil that were obstructing

Is not always the same answer but a site of obstruction must be analized or else you will abandon CPAP or sleep treatment if you dont see the benefits of a good night sleep

I am a believer each patient is unique
And more information lead to better decision

[laserjobs]

Rule of thumb: In sleep medicine the patient is always right


Yes i am on the field of medicine, also patient that why i do almost all lines of treatment from snore pillows to multinivel surgery
Whatever it take to get a good night sleep starting from the less invasive always

Back to the topic:
If the studies suggest there is no other explanation for the arousal that OSA

And Cpap doesnt correct the arousal
As in the pulse events seen in the latest study

Localization the site of obstructiom is the key to solve the problem

In the year i had 2 patients similar cases
Nothing seem to work i did a ( drug induced sleep endoscopy with Precedex
And found huge lingual tonsil that were obstructing

Is not always the same answer but a site of obstruction must be analized or else you will abandon CPAP or sleep treatment if you dont see the benefits of a good night sleep

I am a believer each patient is unique
And more information lead to better decision

You might be on to something here. All of this came on when I became very sick and got edema in my whole body. Mainly my neck, sides, stomach and thighs. It does feel like there is a lump in my throat and sometimes I feel like food and mucus is stuck. Every once in awhile I lose my voice which feels like an obstruction of mucus. I had several infected taste buds come on many months back and that seems to have gone away now but my tongue is still swollen. The ENT said that is nothing to worry about and it doesn't really tell him anything. I had tonsils cripts that I was able to clean out before I saw the ENT. My right eye sometimes feels like there is somthing behind it causing some pressure and it is less adaptable to light than my left eye now. I couple years back I did have an MRI that just showed sinus issues. I am a 40 year old male, 5'9" 150lbs, active and not overweight. Recently I did get a colonoscopy and they found moderate diverticulitis throughout my whole lower intestine. Do you think I should ask my GI doctor to do an endoscopy as well to look for obstructions?

[Pugsy]

Slept well except for the damn mask hitting the bridge of my nose and waking me up. I think I know how to fix it so that should not be a problem going forward. As for altitude I live at 5000 ft above sea level.

Ahh, that explains the O2 then.

I have always told people that I thought this mask thing was the hardest part to this therapy. Gotta find the right mask that fits good, seals good, and doesn't cause problems with the face as in discomfort or decimate the nose (where most issues are).
Keep working with this mask if you basically like it otherwise but don't be afraid to try another type of mask if you can.
Generally most of the mask manufacturers allow a 30 day trial with their masks and if it doesn't work out the DME can swap it out and do a bit of paperwork and get credit for the failed mask without the patient having another mask expense.
The mask makers offer this but often DMEs don't pass it along. They make their own in house rules and pretty much do what they please. If your supplier allows a time period where you can exchange a mask without having to by another (if in doubt.. ask them) then by all means use the time to try other masks. There's nothing stopping you from going back to the first choice if you end up not having success with the other trials.

I hate to see people work for 6 weeks trying to make a mask work and use up any free trial period and not have a chance to try something else if at all possible. If a mask isn't comfortable...and can't be made comfortable fairly easily and quickly...get another mask to try if at all possible..

[laserjobs]

I am using a WISP mask and it seems to seal fine but if I route the hose through the top of the frame it pushes down on the bridge of the nose. So I am just doing to pull it out of the frame and use it that way.

[orlF]

The endoscopy of the upper airways is done as an on consult procesudure on a n ent practice with out sedation or anesthesia, with a flexible nasopharingoscope
https://www.youtube.com/watch?v=4gtRhXIezvU

These is one example of OSA caused by lingual tonsils




Often when people say endoscopy they think in GI , well these is not the case

[laserjobs]

The endoscopy of the upper airways is done as an on consult procesudure on a n ent practice with out sedation or anesthesia, with a flexible nasopharingoscope
https://www.youtube.com/watch?v=4gtRhXIezvU

These is one example of OSA caused by lingual tonsils




Often when people say endoscopy they think in GI , well these is not the case

Makes sense, I will ask about it on my follow-up visit to my pulmonary doctor this Wednesday. I will be seeing my GI doctor in August so I will bring it up with him too.

Thanks!

[laserjobs]

Here are two SpO2 charts the first is before using the APAP and the second is during the use of the APAP. I don't see any real difference do you?

Before APAP


During APAP - Min 4 Max 10 – AHI 1.5 90% 4.5 95% 4.5


During APAP - Min 5 Max 10 – AHI 2 90% 5.5 95% 6

[Pugsy]

I don't see any real difference either.
Sleep apnea isn't all about O2 though (yes, it is important).
I have a friend whose base O2 is in the 95% range (minor COPD issues) and her OSA diagnosis showed 60 plus events per hour and the O2 barely went down to 93% at times.

Me on the other hand...my AHI was less than hers and my base O2 was 98 to 99% and I had desats to 73%.
O2 is important for sure but not the only thing that we look at when evaluating things.

[laserjobs]

I guess my concern is the pulse events and O2 events have not really moved. I have ordered strap type heart rate data logger to see if it will give me different results.

BTW: I hardly ever snore unless I have a had a couple drinks in me. I got referred from my endocrinologist due to low testosterone and polycythemia.